Bunion Surgery: Everything You Need to Know

Surgery for a bunion (hallux valgus) is done to correct a bony outgrowth at the base of the big toe that forces it inward. It can involve cutting/realigning bone, repositioning muscles/tendons/ligaments in the foot, and fusing or replacing a joint, depending on the case. Surgery may also be done for bunionettes, outgrowths that occur just below the pinky toe.

Treatment for bunions is really only indicated when they cause discomfort. Conservative therapies (e.g., wearing a bunion cushion or special foot insert) may be sufficient, but not always. Bunion surgery may be recommended if these options fail and related symptoms—pain, stiffness, swelling, and redness—impact your walking or overall quality of life.

Many are surprised by the extent of the recovery period for bunion surgery. If this procedure has been suggested, you'll benefit from understanding more about exactly what it entails.

Woman's feet with bunions
bgwalker / Getty Images

What Is Bunion Surgery?

Bunion surgery is done to restore the affected toe to its normal position in order to reduce pain and improve function. This surgery is nearly always performed on an outpatient basis, so a hospital stay is not required.

While it seems logical that bunion surgery would involve simply shaving off the bunion, this is not usually effective, as the bunion tends to return over time. Instead, bunion surgery involves removing the bony outgrowth and/or cutting and straightening the affected toe bone.

The surgeon then repositions the surrounding tendons and ligaments in the foot. For instance, the surgeon may tighten the ligaments on the outside of the toe and loosen the ligaments on the inside. This creates the tension needed to restore the toe to its proper position.

If the toe was cut, it may be stabilized and held in place using metal plates, screws, or wires while it heals.

Bunion surgery can be performed using a traditional, open approach in which a larger incision is made on your skin to access the foot. Minimally invasive surgery involves accessing the foot by using small key-hole incisions, special surgical instruments, and an imaging technique called fluoroscopy.

While a relatively fast surgery, bunions are complex deformities, so operating on them requires an experienced foot surgeon.

Minimally invasive bunion surgery takes less time and offers a decreased risk of infection and faster recovery compared to an open procedure. There is also less scarring. That said, research suggests that for mild-to-moderate bunions, the open approach offers a superior functional outcome.

Types

There are over 150 types of surgeries for bunions. Generally speaking, the following procedures are used:

  • Bunionectomy: Removal of the bony outgrowth, plus realignment of the muscles, tendons, and ligaments surrounding the affected joint
  • Osteotomy: Cutting of the toe bone in order to realign the affected joint in a straighter position with pins or screws
  • Arthrodesis: Fusing of the bones surrounding a damaged (and removed) joint using screws, wires, or plates
  • Arthroplasty: Removing the damaged part of a joint and allowing scar tissue to fill the space between the two bones. Sometimes, the joint is replaced with an implant.

In all scenarios, tendons and ligaments are corrected.

The exact procedure performed depends on the severity of the bunion (mild, moderate, or severe), whether arthritis is present in the toe joint, and the surgeon's experience and discretion.

Procedure   Mild Bunion  Moderate or Severe Bunion  Severe or Arthritic Bunion
 Bunionectomy  √  
 Osteotomy    √  
 Arthrodesis      √
 Arthroplasty      √
Soft tissue repair

Be sure to talk with your surgeon about the procedure or combination of procedures they will be using to correct your bunion. Typically, factors like your age, activity level, overall health, and the severity of the bunion are all considered.

Contraindications

Contraindications to bunion surgery include:

Potential Risks

Specific risks associated with bunion surgery include:

  • Stiffness or scarring of the big toe
  • Wound infection
  • Nerve injury resulting in numbness or continued pain
  • Failure of the bone to fully heal (nonunion)
  • Recurrence of the bunion
  • Avascular necrosis of the big toe bone

Purpose of Bunion Surgery

The purpose of bunion surgery is to alleviate pain and restore function by removing the bony outgrowth and realigning the joint.

Bunion surgery is generally considered if you have one or more of the following problems:

  • Significant pain that impairs their ability to engage in normal activities of living (e.g., walking a few blocks with sneakers)
  • Bunion-associated toe pain, redness, swelling, and/or stiffness that persists despite rest or taking a nonsteroidal anti-inflammatory drug (NSAID)
  • Toe deformity (e.g., the big toe begins to overlap or underlap the adjacent toe)

If you are considered a good candidate and decide to move forward with surgery, your surgeon will order special foot X-rays to help plan out the surgery.

You will also need to see your primary care physician for pre-operative tests, such as:

How to Prepare

Once you are scheduled for bunion surgery, your doctor will give you instructions on how to best prepare for the procedure. Following these instructions carefully will help prevent possible complications.

Location

Bunion surgery is performed in a hospital, surgical center, or surgeon's office by an orthopedic surgeon or podiatrist.

Your doctor will probably ask that you arrive approximately one to two hours early on the day of your operation.

Food and Drink

Avoid eating or drinking for eight to 12 hours before surgery. The precise timing will depend on the type of anesthesia you are undergoing, so be sure to ask.

Medications

You will be advised to stop taking certain medications, like NSAIDs, a few days before surgery.

Be sure to tell your surgeon all of the drugs you are taking, including prescription and over-the-counter medications, herbal products, vitamins, and recreational drugs.

What to Wear and Bring

Since you will change into a hospital gown upon arrival at the hospital or surgical center, it's sensible to wear loose-fitting clothes that are easy to remove.

A special boot that will be placed on your foot after surgery, so you might opt for loose-fitting sweatpants that can easily fit around it. You can also consider bringing shorts to change into before you go home.

As for shoes, you'll need a supportive, non-slip shoe with a rubber sole to wear on the foot that was not operated on.

Leave jewelry, including any body piercings, at home.

Be sure to bring:

  • Driver's license and insurance card
  • List of your medications
  • An assistive device, such as crutches or a knee walker, to be used after surgery (talk with your surgeon beforehand about what device they recommend)

You will not be able to walk or drive yourself home after surgery. Remember to arrange for a friend or family member to transport you back home.

Pre-Op Lifestyle Changes

Besides optimizing any underlying health conditions you have (e.g., diabetes or high blood pressure), your surgeon will advise you to stop smoking at least a few weeks before your operation. Smoking increases your risk of wound and bone healing problems after surgery.

What to Expect on the Day of Surgery

On the day of your bunion surgery, you will arrive at the hospital or surgical center where you will check-in. At this time, your insurance may need to be verified and you may be asked to sign various consent forms.

Before the Surgery

You will be taken to a pre-operative room where you will change out of your clothes into a hospital gown. A nurse will then review your medication list, record your vitals (heart rate, blood pressure, etc.), and place an intravenous (IV) line into a vein in your arm for administering fluids and medications.

Your surgeon and possibly an anesthesiologist will come to say hello and briefly review the operation with you. From there, you will be wheeled into the operating room on a gurney where the anesthesia process will start.

During the Surgery

Bunion surgery may be performed under local, general, or spinal anesthesia.

  • Local anesthesia: The surgeon will inject a medication into your ankle that will numb your entire foot. You may feel a stinging sensation as the medication is being injected. You will also be given a sedative to help you relax and fall into a light sleep during the procedure.
  • Regional anesthesia: An anesthesiologist will inject a numbing medication into your lower back (spinal block) or behind the knee (popliteal block). You will be conscious, but you will not feel any pain or other sensation in the numbed part of your body. You will also be given a sedative.
  • General anesthesiaAn anesthesiologist will put you to sleep by giving you inhaled or intravenous medication. You will not remember or feel anything that occurs during the surgery. After you are asleep, the anesthesiologist will insert a breathing tube called an endotracheal tube through your mouth and into your windpipe. The tube is connected to a ventilator.

Once the anesthesia has taken effect, a surgical assistant will clean the skin on the foot being operated on using an antiseptic solution to kill any bacteria.

The precise flow of surgery will depend on the specific bunion procedure(s) being performed. That said, you can generally expect the following steps:

  • Incision: The surgeon will make one or more incisions along the inside of or on top of the affected joint. The size of the incision depends on whether the surgery is open (larger) or minimally invasive (smaller).
  • Bone removal and/or cutting: The surgeon will then perform one or more specific procedures based on the severity of the bunion (e.g., removing the bunion or cutting the bones to realign the joint).
  • Bone stabilization: If the toe bone was cut, it will be held in place with screws, plates, or wires.
  • Soft tissue repair: The soft tissues (tendons and ligaments) around the affected toe will be shortened or lengthened to bring the affected toe back to its proper position.
  • Closure: The incision(s) will be closed with stitches and your foot will be wrapped in a soft gauze bandage. A special supportive boot with self-fastening closures will then be placed over your foot.
  • Prep for recovery: If you were given general anesthesia, it will be stopped. The breathing tube will be removed and you will wake up. You will then be taken to a recovery room.

Operation time for bunion surgery is usually less than one hour, but may be longer based on what procedures are being performed. In the vast majority of cases, one foot is operated on at a time. A second surgery is scheduled if a patient requires bunion surgery on their other foot.

After the Surgery

In the recovery room, a nurse will monitor your vital signs. Once you are alert (around one to two hours after surgery, or longer if you underwent general anesthesia), you will be discharged home.

Recovery

As you recover at home, you will have various instructions to follow.

These instructions often include:

  • Keeping your foot elevated on one or two pillows to minimize swelling. Your doctor may also recommend icing your foot.
  • Taking medication as prescribed (e.g., opioid medication for pain; antibiotics to help prevent infection).
  • Keeping your incision site dry. For showering, your surgeon may advise you to remove your boot and cover your surgical dressing with a plastic bag and tape.
  • Avoid placing any weight on the operated foot (the timeline will depend on your surgeon's guidance). When you have to walk, use an assistive device.
  • Avoid driving for a week or more until you are off all pain medications.

Since you can’t move around much in the first couple of weeks after bunion surgery, be sure to arrange to have some help with shopping and chores during this time.

Your surgeon may also recommend daily foot and toe stretching exercises during recovery to help you regain strength and range of motion in the foot after surgery. Be sure to adhere to these exercises to optimize your surgical outcome.

Expect to follow-up with your surgeon about around one to two weeks after surgery. At these appointments, your dressings will be changed and your stitches will be removed, respectively.

Keep in mind that even if your surgeon allows you to remove your boot at one of these follow-up appointments, you will likely still have to wear a foot brace or splint for four to 10 more weeks.

When to Call a Doctor

Call your surgeon if you experience any of the following symptoms:

  • Fever or chills
  • Redness, swelling, bleeding, or pus-like drainage from the wound site
  • Increased pain around the foot or wound site
  • Swelling in the calf of the operated-on foot
  • Trouble breathing


Long-Term Care

While you can expect to begin placing weight on your operated-on foot around two to six weeks after surgery, you will still need to use an assistive device for up to 12 weeks after your operation. At this point, or when the swelling fully resolves, you can begin wearing and walking with an athletic or soft-leather shoe.

The width of your forefoot will not change dramatically after bunion surgery. In fact, the average correction of forefoot width is just a fraction of an inch. Still, while some patients may be able to wear slimmer shoes eventually (at least six months after surgery), others may not.

Possible Future Surgeries

Future surgeries may be warranted if surgical complications arise. For example, if the bones do not heal after an osteotomy and realignment, another surgery may be warranted. Likewise, if a new problem develops as a consequence of the surgery—for example, if the deformity is overcorrected and the big toe points inward—you may have to undergo revision surgery.

Bunions can also rarely recur months or years down the road, especially if there is an inadequate correction of the initial deformity (e.g., shaving off the bunion without correcting the soft tissues of the foot). Surgical correction of bunion recurrence can be challenging and extensive.

Lifestyle Adjustments

Continuing to not smoke after surgery is essential for reducing wound healing complications.

To prevent your bunion from recurring (or from forming in the other foot), it is important to wear shoes that are comfortable and have a wide toe box (so your toes have ample wiggle room) and good arch support. If you have to wear shoes with a narrower toe box, do it for as short of a time as possible.

Maintaining a normal body weight can also help prevent bunion recurrence.

A Word From Verywell

Making the decision to undergo bunion surgery can be difficult. You need to weigh your symptoms and their impact against the extensive recovery time and/or the possible risks of surgery, including continued pain, toe joint stiffness, or bunion recurrence.

The good news is that having a bunion, even a severe one, is not a medical emergency. This means that you can take your time weighing the potential pros and cons of having the procedure. If you can't decide, seeking a second opinion may be helpful.

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Article Sources
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